ABSTRACT
We surveyed the records of 21 of the 28 snakebite victims seen at King Fahad National Guard Hospital in Riyadh over the 20-year period 1986-2005. The most common symptoms were local pain and swelling and the most common signs oedema and tenderness. Neurotoxicity was not noted in any case. Coagulopathy was recorded for 14/21 patients (66.7%) and 5/19 (26.4%) had leukocytosis. All patients were given tetanus toxoid (100%) and 20 (95.2%) received antivenom. Blood products were administered in 2 cases and prophylactic antibiotics in 10 (47.6%). No allergic reaction to antivenom was reported.
Subject(s)
Hospitals, Urban , Patient Admission , Snake Bites/epidemiology , Snake Bites/therapy , Adult , Age Distribution , Animals , Anti-Bacterial Agents/therapeutic use , Antivenins/therapeutic use , Crotalus , Edema/etiology , Female , Humans , Leukocytosis/etiology , Male , Pain/etiology , Patient Admission/statistics & numerical data , Retrospective Studies , Saudi Arabia/epidemiology , Seasons , Sex Distribution , Snake Bites/complications , Snake Bites/diagnosis , ViperidaeABSTRACT
We surveyed the records of 21 of the 28 snakebite victims seen at King Fahad National Guard Hospital in Riyadh over the 20-year period 1986-2005. The most common symptoms were local pain and swelling and the most common signs oedema and tenderness. Neurotoxicity was not noted in any case. Coagulopathy was recorded for 14/21 patients [66.7%] and 5/19 [26.4%] had leukocytosis. All patients were given tetanus toxoid [100%] and 20 [95.2%] received antivenom. Blood products were administered in 2 cases and prophylactic antibiotics in 10 (47.6%). No allergic reaction to antivenom was reported
Subject(s)
Snake Venoms , Antivenins , Retrospective Studies , Snake BitesABSTRACT
BACKGROUND: The study was designed to examine the value of post-operative and post-ablative serum thyroglobulin levels and diagnostic whole body scan in predicting remission in patients with differentiated thyroid carcinoma. METHODOLOGY: Serum TG levels and diagnostic iodine-123 whole body scans performed prior to and 6-12 months after 131I ablation for DTC were evaluated in 100 consecutive patients at King Faisal Specialist Hospital Riyadh. Patients were followed up for a period of 7.6 years (range 7-10 years). All patients underwent total thyroidectomypriorto 131I ablation. RESULTS: Patients with serum TG levels < 8 ng/ml post thyroidectomy (50 patients) also maintained low TG < 8 ng/ml after 131I ablation and had better outcome (60%) remission. On the other hand DTC subjects with higher TG > 8 ng/ml post thyroidectomy (50 patients) 40% remained in remission X2 = 4.00, p = 0.046. For the group with initial high post-operative TG, it became < 8 ng/ml in 34/50 (68%) patients after ablation with 131I and in this subgroup, remission was seen in 16/34 (47%) of patients in contrast to 4/16 (25%) remission rate in those who continue to have TG > 8 ng/ml after ablation. At the end of follow up, 123I-WBS was positive in 4% and 10% of patients with initial TG < 8 ng/ml and TG > 8 ng/ml respectively; X2 = 1.38, p= 0.24. CONCLUSION: Post-operative and post-ablative serum TG levels -but not follow up diagnostic WBS- have predictive values and permit selection of patients with higher risk for persistent/recurrent disease.
Subject(s)
Iodine Radioisotopes/therapeutic use , Postoperative Period , Thyroglobulin/blood , Thyroid Neoplasms/surgery , Thyroidectomy , Adult , Female , Humans , Male , Prognosis , Prospective Studies , ROC Curve , Remission Induction , Time FactorsABSTRACT
Radioactive iodine (131I) plays a major role in the diagnosis and management of differentiated thyroid cancer (DTC); however, data on the use of the 123I isotope in DTC are limited. We compared 238 diagnostic whole body scans performed 24 h after oral ingestion of 185-555 MBq 123I with their corresponding 131I posttherapy whole body scans obtained 4-5 d after 131I therapy. We studied scans in 3 clinical situations: with the first 131I therapy, with the second 131I therapy, and in cases of elevated Tg and negative diagnostic scan. One hundred and seventy-seven pairs were obtained with the first 131I therapy and showed complete concordance between pretreatment and posttreatment scans in 166 pairs (concordance rate, 93.8%). Six other posttreatment scans showed more foci in the thyroid bed than the pretreatment scans, but no evidence of uptake in new areas. Only 5 posttreatment scans showed foci in new locations: 3 in cervical lymph nodes (CLN), 1 in the lung, and 1 new bone metastasis in a patient with known skeletal metastases. With the second 131I therapy, 34 pairs were obtained and showed complete concordance in 28 pairs (concordance rate, 82.4%). Five discordant pairs showed additional foci in areas that were already positive on pretreatment scans. Only 1 posttreatment scan showed a new bone metastasis in a different site from the bone metastases that were seen on its corresponding pretreatment scan. Of 27 pairs of scans in patients with elevated Tg and negative pretreatment scans, 15 posttreatment scans remained negative, 6 posttreatment scans showed an uptake in the thyroid bed, and 3 other posttreatment scans showed lung uptake in patients whose computed tomography scans of the chest showed only bronchiectasis (in 2 patients) and lung scarring (in the third patient) without evidence of lung metastases. Three posttreatment scans showed definite uptake (in thyroid bed, thyroid bed and lung, and CLN) compared with their corresponding pretreatment scans, which were initially reported negative but were retrospectively thought to have had faint uptake. In 56 pretreatment scans, the 123I diagnostic activity was 185 MBq, and the results showed complete concordance in 54 pairs. Two posttreatment scans showed additional uptake: 1 in the bone and 1 in CLN. These data suggest that pretreatment scanning using 123I is highly comparable to 131I posttreatment scanning and that 123I is an excellent diagnostic agent in DTC.
